Healthcare Provider Details

I. General information

NPI: 1750183638
Provider Name (Legal Business Name): AMANDA MICHEL ROGERS PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2025
Last Update Date: 03/24/2025
Certification Date: 03/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2013 LIVE OAK BLVD STE B&C
SAINT CLOUD FL
34771-8408
US

IV. Provider business mailing address

6984 SMITHSHIRE LN
WINDERMERE FL
34786-6679
US

V. Phone/Fax

Practice location:
  • Phone: 407-593-2388
  • Fax:
Mailing address:
  • Phone: 407-483-6016
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number11038392
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: